Provider Demographics
NPI:1497249007
Name:CLOUSE, KANSYS
Entity Type:Individual
Prefix:
First Name:KANSYS
Middle Name:
Last Name:CLOUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2549 QUEEN ST # 2
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:OR
Mailing Address - Zip Code:97138-7370
Mailing Address - Country:US
Mailing Address - Phone:406-396-7083
Mailing Address - Fax:
Practice Address - Street 1:1639 SE ENSIGN LN # B103
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:OR
Practice Address - Zip Code:97146-7308
Practice Address - Country:US
Practice Address - Phone:503-338-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201808580NP-PP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner